Dr Ann Allisa Church, MD is a medicare enrolled "Dermatology - Dermatopathology" physician in St Johns, Florida. Her current practice location is
132 Dundee Pl, St Johns, Florida. You can reach out to her office (for appointments etc.) via phone at
(800) 330-6770.
Dr Ann Allisa Church is licensed to practice in Florida (license number ME97605) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1205905486.
Physician's Profile
| Full Name | Dr Ann Allisa Church |
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| Gender | Female |
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| Speciality | Dermatology - Dermatopathology |
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| Location | 132 Dundee Pl, St Johns, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1205905486
- Provider Enumeration Date: 11/06/2006
- Last Update Date: 01/29/2024
Medicare PECOS Information:
- PECOS PAC ID: 5597802884
- Enrollment ID: I20091019000349
Medical Identifiers
Medical identifiers for Dr Ann Allisa Church such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1205905486 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207N00000X | Dermatology | ME97605 (Florida) | Secondary |
| 207ND0900X | Dermatology - Dermatopathology | ME97605 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Ann Allisa Church allows following entities to bill medicare on her behalf.
| Entity Name | Bernhardt Laboratories Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1235893405
PECOS PAC ID: 5799755278
Enrollment ID: O20220409000201 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ann Allisa Church is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Ann Allisa Church, MD
14275 Midway Rd Ste 400,
Addison, TX 75001-3661
Ph: (866) 697-8378 | Dr Ann Allisa Church, MD
132 Dundee Pl,
St Johns, FL 32259-8223
Ph: (800) 330-6770 |
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